Gonçalo Ávila, Marisa Roldão, Hugo Ferreira, Inês Coelho, Teresa Chuva, Ana Paiva, José Maximino Costa
{"title":"Kidney transplantation in multiple myeloma in 2023: A short review.","authors":"Gonçalo Ávila, Marisa Roldão, Hugo Ferreira, Inês Coelho, Teresa Chuva, Ana Paiva, José Maximino Costa","doi":"10.5414/CN111241","DOIUrl":null,"url":null,"abstract":"<p><p>Patients with multiple myeloma (MM) frequently present with kidney involvement, of which a non-negligible proportion will progress to end-stage kidney disease. Kidney transplantation (KT) is the preferred kidney replacement therapy for selected patients; however, there are still many uncertainties regarding its application in MM patients. The risk of hematological relapse and subsequent graft loss or patient death often leads nephrologists to deem these patients unfit for KT. As such, data on KT in MM patients are heterogeneous and originate from individual case reports and small case series. Although MM is still an incurable disease, the addition of newer drugs and autologous hematopoietic stem cell transplant (HSCT) in the standard of care has been increasing patients' overall survival in recent decades. Risk stratification using cytogenetic studies and minimal residual disease detection are helpful in assessing the risk of relapse in patients who attain a complete response after HSCT. The greatest challenges remain the correct identification of patients who will most probably benefit from KT from a survival perspective and the determination of how long relapse-free survival should be before the transplant is performed.</p>","PeriodicalId":10396,"journal":{"name":"Clinical nephrology","volume":null,"pages":null},"PeriodicalIF":1.1000,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5414/CN111241","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Patients with multiple myeloma (MM) frequently present with kidney involvement, of which a non-negligible proportion will progress to end-stage kidney disease. Kidney transplantation (KT) is the preferred kidney replacement therapy for selected patients; however, there are still many uncertainties regarding its application in MM patients. The risk of hematological relapse and subsequent graft loss or patient death often leads nephrologists to deem these patients unfit for KT. As such, data on KT in MM patients are heterogeneous and originate from individual case reports and small case series. Although MM is still an incurable disease, the addition of newer drugs and autologous hematopoietic stem cell transplant (HSCT) in the standard of care has been increasing patients' overall survival in recent decades. Risk stratification using cytogenetic studies and minimal residual disease detection are helpful in assessing the risk of relapse in patients who attain a complete response after HSCT. The greatest challenges remain the correct identification of patients who will most probably benefit from KT from a survival perspective and the determination of how long relapse-free survival should be before the transplant is performed.
多发性骨髓瘤(MM)患者常伴有肾脏受累,其中相当一部分患者会发展为终末期肾病。肾移植(KT)是选定患者的首选肾脏替代疗法;然而,在 MM 患者中应用肾移植仍存在许多不确定因素。血液病复发的风险以及随后的移植物丢失或患者死亡往往导致肾病专家认为这些患者不适合接受 KT。因此,有关 KT 在 MM 患者中应用的数据各不相同,且均来自于个别病例报告和小型病例系列。尽管MM仍是一种不治之症,但近几十年来,在标准治疗中增加了新药和自体造血干细胞移植(HSCT),患者的总生存率不断提高。利用细胞遗传学研究和最小残留病检测进行风险分层,有助于评估造血干细胞移植后获得完全应答的患者的复发风险。最大的挑战仍然是如何从生存角度正确识别最有可能从 KT 中获益的患者,以及如何确定在进行移植前无复发生存期应为多长。
期刊介绍:
Clinical Nephrology appears monthly and publishes manuscripts containing original material with emphasis on the following topics: prophylaxis, pathophysiology, immunology, diagnosis, therapy, experimental approaches and dialysis and transplantation.